I am will be offering chat rooms once a month to allow current participants to discuss career and college topics. Please complete the following survey to assist with designating convenient days and times for these activities. 

1

First and Last Name

First and Last Name

2

I am available at the following times to log into a chat room. Please select all that apply.

I am available at the following times to log into a chat room. Please select all that apply.

	Mondays	Tuesdays	Wednesdays
5 PM	I am available at the following times to log into a chat room. Please select all that apply.	I am available at the following times to log into a chat room. Please select all that apply.	I am available at the following times to log into a chat room. Please select all that apply.
6 PM	I am available at the following times to log into a chat room. Please select all that apply.	I am available at the following times to log into a chat room. Please select all that apply.	I am available at the following times to log into a chat room. Please select all that apply.
7 PM	I am available at the following times to log into a chat room. Please select all that apply.	I am available at the following times to log into a chat room. Please select all that apply.	I am available at the following times to log into a chat room. Please select all that apply.

3

Please list any additional days and times you are available.

Please list any additional days and times you are available.

4

I am interested in the following career(s). Please select all that apply.

I am interested in the following career(s). Please select all that apply.

Engineering (Aerospace, Bio-engineering, Chemical, Civil, Computer, Electrical, Mechanical, etc.)

Life Science (Agricultural, Biological, Cellular Biology, Marine Biology, Neuroscience, Zoology, etc.)

Mathematics (Algebra, Applied, Computing, Geometry, Logic, Operations, Statistics, etc.)

Physical Sciences (Astronomy, Atmospheric Science, Chemistry, Geological & Earth Science, Ocean/Marine, Physics, etc.)

Psychology (Behavioral, Clinical, Counseling, Human Development, etc.)

Social Science (Anthropology, Criminal Justice, Economics, Geography, Linguistics, Political Science, Sociology, etc.)

Other, please list. If other, type text here.

5

I am interested in learning more about the following college preparation topics.

I am interested in learning more about the following college preparation topics.

Financial Aid

Clubs and Organizations

Study Abroad

Academic Preparation

Time Management

College Application Overview

Scholarships

Masters and PhD programs

Healthy Life Styles

Other, please list. If other, type text here.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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